Lesion Volume Changes Predict Rate of Whole-Brain Atrophy in Multiple Sclerosis

Presenting at CMSC 2022, researchers analyzed the development of whole-brain atrophy and white matter lesions in patients with CDMS.

White matter lesion changes that occurred during the initial demyelinating event in patients with clinically definite multiple sclerosis (CDMS) predicted rate of progression of whole-brain atrophy, according to study results presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held from June 1-4, in National Harbor, Maryland.

Researchers retrospectively analyzed 5 consecutive years of annual brain scans of 392 patients enrolled in the REFLEX/ION study. These patients presented with an initial demyelinating event in clinic with 262 receiving early baseline treatment and 130 receiving delayed treatment after 24 months of subcutaneous interferon beta-1a. Of the 392 patients, 162 were diagnosed with CDMS, while the remaining 230 were not.

The researchers assessed for global and central brain atrophy by determining brain volume using FSL-SIENA — an automated method used in brain magnetic resonance imaging studies. The annual percentage of volumetric changes occurring in the brain and ventricles as well as the total lesion volume change increased more rapidly for patients with CDMS compared with patients without CDMS (all P <.01). These changes were not impacted by whether the patient was treated early or late with interferon beta-1a.

Within the 1st year, patients in the early treatment group demonstrated increased brain volume atrophy and lesion volume loss attributable to pseudoatrophy and resolving edema, respectively, compared with patients in the delayed treatment group. However, after the 2nd year, patients in the early treatment group experienced slower brain and ventricular atrophy than those in the delayed treatment group.

Increased total lesion volume change significantly predicted increased brain atrophy in the subsequent year. Adjusting for confounding factors within the 1st treatment year by removing it from the statistical analysis resulted in a stronger relationship between total lesion volume changes and subsequent rate of brain atrophy. This relationship was observed only in the early treatment group during more stable treatment phases following the 1st year.

“White matter lesions and whole-brain atrophy progressed faster in patients with CDMS…,” the researchers concluded. “The rate of whole-brain atrophy is predicted by previous lesion volume change.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mattiesing R, Gentile G, Brouwer I, et al. Development and interrelation of whole-brain atrophy and lesion volume in patients with a first clinical demyelinating event in the REFLEX/ION study. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract DMT22.